Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Registration Information Unchanged 11200 5600 0 Form and Instruction CMS-855O Enrollment Application
Initial Application Modified 36000 18000 0 Form and Instruction CMS-855O Enrollment Application
Reporting Voluntary Withdrawal of Registration Information Unchanged 56000 14000 0 Form and Instruction CMS-855O Enrollment Application
Total burden requested under this ICR: 103200 37600 0  
To view an IC, click on IC Title